HomeMy WebLinkAboutM2019-0048 - Permit ApplicationM 2-01q - 0o Lq V
Pdnc Form Wo eet for Combo Building &Solar Permit Application
r" Gomm'I " Residential NOTE; Pity of Newport Beach - Building Division
LAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r" Grading inage r" Else r- Mech Plum r �— -
r Cu YdCut� CU Yd Fill
Project
Address (Not mailing address) r Flood (— FI a iq r" Landslide 1—N/A Floor
I P l%�1 oV � F I �l� t �� � Suite
Des rI tfon of Work /gyp 1
G 0 ' s F Const Type
# Storlesr # Units (if Res)F
New/AddSF�— RemodelSFF � Garage/New/Add -- Valuations
Material/Labor I cm
OWNER'S NAME Last �}}�
First 1
Owner's Address AFT
� �
I � - Owner's E-mail Address
I tT
City-�. e State FTX_
Zip r°/�? TelaphoneF�
APPLICANT'S NAME Last CHUNG---------------
Applicant's Address
6351 INDUSTRY WAY
City WESTMINSTER State CALIFORP
ARCHITECT/DESIGNER'S NAME
Last �—
Archiitect/�Designe`r's A�d'dress
City 9 State �r—
Applicant's Email Address
JACQUELYN. CH UNG@SBOG LOBAL'NET
Zip 92683 Telephone 49.831',3121
Lic. No. I —
Architect(Designar's. E-mail Address
Zip F� TelepltoneF�
ENGINEER'S NAME Last PETROV
First IPLAMEN Lie. No. 6947
Engineer's Address Engineer's E-mail Address
8191 CASITAS COURT P.PETROV@PMA-BG,COM'
City LAGUNA NIGUEL State CALIFORD Zip 2677 Telephone 714.7'17.7542
CONTRACTOR'S NAME/COMPANY SWIFT SLIP DOCK AND PIER BUILDERS,
INC. Lic. No.
Contractor's Address
6351 INDUSTRY WAY
City FE8TMN8TER State CALIFORh
Contractor's Email Address
ACQU ELYN.CH UNGOSBCGLOSALAET
Zip 92883Telephone 949,.631.31.21.
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGH
PLAN CHECK NO.
USE ZONE DEVELCJPMENT NO
PLAN CHECK FEES$
20